Keep on sucking

Just got back from Sheffield having got the vacuum dressing reinstated.
The new pump was delivered to my home Sunday evening ready for my clinic visit. First rate service I thought.
The dressing nurses couldn't believe how much tape had been applied to get an airtight seal when the dressing was first fitted. They stripped everything off and started again. As I suspected the pain of having my leg hairs ripped out was far worse than anything I have had from the wound so far, although as I type this I am having second thoughts as the pain killers are wearing off.
The wound is healing well, such that they have not bothered to reinstate the vacuum over part of it. Perhaps that's just as well as it took two nurses over 2 hours to replace the dressing and get it airtight. Much less leg covered with sticky tape this time so a much neater job.
District Nurse will replace the dressing on Thursday and it's back to Sheffield next Monday.

For the devotees of gory photos I apologise for not taking my camera today. Apparantly when the white foam was removed (we left it in place on Saturday when the pump died) you can see the bone down the hole. Must try and get a shot next week if possible.

Missing Photos

I'm not sure how these missed the last post. They are also in reverse sequence, with the gory ones first, sorry! You can just see the white foam packing in the wound on the first pictures.

The second set are Chris and Diane (with me in the background - my apologies)

The third set is the before and after of the wound.

See previous post for the full story

Back Home Again

Well, I now have my vacuum dressing in place after an interesting trip to hospital.
After the ambulance didn't appear on Monday it was arranged for early on Tuesday when, fortunately, it turned up. I arrived on the Ward at a busy time and it took a while to get organised by which time the Consultant was on the phone from Theatre wondering where I was! I was rushed down to theatre and given a general anaesthetic so they could scrub the wound clean before fitting the dressing.
I thought a before and after view might be interesting.

When I awoke I found myself attached to a small plastic brick which makes some very unpleasant noises all the time. Well, no more trips to the library for me - Sshh! In order to get an airtight seal they have had to apply a lot of tape to my leg which impinges on about 10 of my pin sites (with 28 sites there are plenty to go around). Since the dressing requires changing every week it looks like I will need a good long book to read while they apply the tape. I suspect that I get a free leg-wax into the bargain.
After a decent nights sleep I was told by the Dr's that I could go home. Sadly there appears to be an ambulance shortage and they couldn't find one to take me home on Wednesday. Thursday arrived and still no ambulance. I was about to get a friend to come and spring me from my jail cell but following discussions with the ward sister and the occupational therapist we decided that I could go home by medicar. I think that has now set a precedent as I now have a car booked to take me back for the dressing clinic on Monday morning.
I have become accustomed to the noise of the suction when I am sleeping, but it irritates the heck out of me when I am listening to quiet music or speech on the radio. It is a pain to carry around and the tube between the pump and my leg must be 8 foot long. If I trip over the tube and break another bone I shall be very unhappy.
That said, I am much happier with this set up than the open wound leaking blood when I walk. It also protects the wound and promotes healing so infection risks are reduced and that has to be good. Apparantly most of the wound was forming new skin and it was only a small hole that was still open so that too is positive.
As for the heel pain, the antibiotics seem to be working and I am pretty much back to normal levels of discomfort now.

UPDATE:
6:30 pm Saturday - Vacuum machine broken "Internal Device Error".
Suppliers suggest removal of sponge dressing and return of unit for fixing. They will supply a replacement, hopefully for Monday.
District nurses (Chris and Diane) hack off the sealing film around the wound site, and replace sponge with another temporary dressing - good photo-op! They leave just after midnight.

Having removed the black foam the main wound looks reasonably OK and the hole which goes down to the bone is packed with white foam which the hospital (night staff nurse on the ward where I spent by internment) suggests we leave in place (Thank You!)
District nurse (Marilyn) comes Sunday morning to check. There has been some leakage so she adds a bit more dressing.
Here's hoping that the new unit makes it to Sheffield for Monday so I can be plugged in again.

Heel Pain - Update

I've decided it is an infection.
The pain is really intense and even my strongest painkillers won't shift it for long.
I have started a course on antibiotics to try and calm things down and was really looking forward to seeing the medical staff in Sheffield today so they could take a look and advise me. That was when I found out there was a problem with the transport and I won't be going today after all. The latest plan is for me to go very early tomorrow just in time for theatre. Not a great plan but the best we have to work with. In any event I need to get the wound dealt with quickly so whatever it takes......

Heel Pain

On the eve of my return to Sheffield to have the new wound dressing fitted I have really been struggling with heel pain. The area under my left heel has swollen and it is really painful to stand, let alone, walk on. There doesn't seem to be any evidence of infection so I am assuming it is bruising, perhaps from one of the footbeds I have been using in my temporary built up shoe in an attempt to make walking more comfortable. Another possibility is that when Maria tightened the wire on Thursday it placed additional strain on the other wire through my heel.
Hopefully someone will tell me what is happening when I get to the ward tomorrow. I am taking extra painkillers but walking is still really bad news.
I have had some positive feedback on the suction dressing from a couple of previous wearers. They both report positive results but the idea of fitting it under the Lizzie still concerns me, especially as it appears I have to change the dressing every 2 days.
Still, time will tell, and any respite from bleeding every time I stand up will be really welcome.

Seven Weeks - Good News/Bad News

The clinic session today was to X-Ray my back and check the healing. The good news is that it is on target to be fully healed in another 4-5 weeks. In preparation for that I can now start weaning myself off the brace. Initially just a few periods of sitting without it, but to be ready to do without it completely in another month or so. In practice I shall still be very wary of walking without it. As the Consultant said, "You do not want to fall over without the brace until you back is fully healed".
Unfortunately, the same optimism didn't run to the wound on my left leg. It is still bleeding when I walk and it is a major infection risk to the bone junction which is supposed to be forming. Careful removal of a section of the "scab" showed a mass of something which looks rather unpleasant. A swab has been taken to test for infection, but it apparantly most likely to be liquid fat! Why can't the fat I want to get rid of just leak away like that?
After some debate about plastic surgery, the decision was taken to take me in next week to clean the wound and fit a "sucky dressing". I was introduced to a fellow patient who has one of these and it appears to be a portable vacuum pump connected to a pipe which leads to the sealed wound. It is supposed to be almost impossible to fit one of these under an existing "Lizzie", but when did that stop anyone trying. It has been done before so why not again?
So, Monday I get driven over to Sheffield for theatre on Tuesday and, I hope, home on Wednesday. At least it will stop me leaking on the carpet and protect the wound from infection meaning I can venture outside a little when the weather is clement.
Apart from these big things I had been having some pain from a pin site in my foot. As Maria suspected the wire was loose - how did that happen? The tightening was totally painless.
I also discovered that a pin which was giving me some grief a few weeks ago has cheese-wired about 7mm through my leg. Just shows what happens when your muscles start working again. I reaaly am a lot more stable than I was and even the stairs are seeming less daunting.
Finally, Maggie goes back to work on Monday. We have an hours care each morning to get me washed and downstairs after Maggie has left for work. What a shame I'll get one day of this and then miss 2 days. C'est la vie!

Six Weeks On

It's now 6 weeks since I was united with my metalwork. Things are still progressing to plan as best I can tell. Without wanting to tempt fate I haven't yet acquired a pin site infection and my painkiller regime seems to keep me pain (but not discomfort) free most of the time.

On a really positive note I am now feeling much more alert and have just been reunited with my work laptop and can now pick up emails from my office. The next breakthrough will be to get back to doing something useful even if it has to be done remotely as I don't intend to go back into an office environment until my leg wound has healed properly as that is the biggest risk of infection, much more so than my pin sites.

Perhaps now is a good time to reflect on what I have learned over these 6 weeks. In no particular order I offer the following personal guidence:

1. Get over it! Once I had realised that it wasn't a dream and that I wasn't going to wake up without broken bones I realised that I had no option to accept what fate had delivered. Be positive, everyone is doing their best to help you, but ultimately your attitude and actions will be the biggest factor. If nothing else, just remember that the alternative is far worse.
2. Seek help. This will naturally come from friends, family and colleagues, but also from the various agencies both government and charity funded. Before I came home we were loaned various items such as toilet frames and bed levers to make it easier for me to manage. I have just had a Social Services assessment to see what assistance they can provide to make it possible for Maggie to go back to work. I also have an emergency alarm button around my neck which will automatically connect to a 24x7 call centre in case I need assistance. This is important for Maggie to make her comfortable to go out and leave me without chaining me into a chair so that I can't hurt myself. There are other agencies who focus on getting the injured party i.e. me, back to work by offering such services as transportation, specialist furniture etc. I have also previously mentioned Slim's website but he also moderates a Yahoo group which is very active and can provide much needed moral and practical support - http://finance.groups.yahoo.com/group/Ilizarovs-and-fixators/. Bear in mind that positive support from whatever source is a force you can channel to strengthen your own resolve should you ever need it.
3. Be realistic. Don't set yourself targets that are either too ambitious or so far away that you can't see how close you are to achieving them. Try to take things a week or two at a time and guage your progress on that basis. One really powerful measure is your response to any physio you are having. You will be able to see the increase in repetitions and how much easier it is to do certain exercises. If you don't have any externally imposed targets then try and invent a few yourself to keep you focussed.

OK then, what practical hurdles have I had to overcome and what is still giving problems.

1. Pin sites. Although I have had no infection as yet, they remain a source of wonderment. I am on a weekly regime of changing dressings which Maggie does for me. This takes about an hour and involves cleaning with Hydrex and replacing the dressings over the wounds. This is complicated by the open wound which keeps bleeding. Depending on whether and to what degree my leg is elevated I get blood flow over a number of the pin sites. By agreement with the nurses we do not put dressings onto those pins but just clean the worst off the pin with hydrex and leave it. The wound itself is not dressed. This process is a chore and different hospitals advise different procedures but we are now into a routine and it does give a regular opportunity to note any changes in the appearance of the sites.
2. Clothing. Slim's sites have some really useful patterns for adapting trousers to go over the frame. Even in my youth I never had flares quite as wide as those necessary here, but I guess fashion is fickle. Personally, rather than cover the frame fully, we have adapted a pair of jogging pants to open down the seam and put toggles and loops on the sides to fasten them with the leg terminating part way down the frame. This is mainly to give the wound some air circulation unless I need to cover it when going out.
3. Protection. The leg itself needs protection from extremes of temparature (in England this means cold as we rarely have to worry about overheating our Lizzie). You can get covers made up which fasten with velcro, but because I have a foot fixing on the frame this wouldn't work well so we use a quilted pillow case which is put over my foot and leg and fastened with string or velcro above the frame. Not really suitable for walking in, but at present I am only going out to hospital appointments and have ambulance transport which involves wheelchair transfers so not an issue. Protection is also needed for anything that might come into contact with the frame as it has several sharp points. We have managed to find a suitable rubber sleeve to cover a sharp end of screw threaded rod which sticks out the back of the frame. I think this came off Maggies sewing machine, but I'm sure there are more conventional sources. Bear in mind that when elevating your foot the frame will be resting on something that you probably don't want to puncture so look for, and do something about, any sharp projections from pins and frame components. I do not concern myself too much about protecting the public from my frame, at present I need all the advantages I can get.
4. Footwear. This is still an on-going saga. The OT unit made me up a platform shoe for my left foot to compensate for the bone they removed. This was fine initially but as I walk more I am noticing its limitations. I am currently supplementing this with a footbed from an old pair of trainers but we need to improve on this. I have studied Slim's solutions (from the website) and plan to try and adapt these to fit my foot. My problem is the pin directly into my heel and the position of the side pins which make it necessary to remove the whole heel cup of the shoe. I am afraid that this will make the shoe liable to fall off which will be a problem half way up the stairs. I will provide details when we solve this problem.

My other challenges have been more related to my other injuries than to the frame. It has taken ages to get comfortable sleeping on my back. Last night was a revelation as Maggie bought and fitted a foam "egg roll" between the mattress and the sheet which spreads the load wonderfully and stops me sliding down the bed as quickly as I was doing without it. Since bed is the only place where I don't need to wear the brace for my broken back this is a real bonus.

Apart from some more visits from friends & colleagues (it's costing a fortune in tea and biscuits but I wouldn't change it for the world), there's nothing to look forward to now until my next visit to Sheffield on 19th January. They are going to check my back and it may see the start of the end of the brace. I have a new physio exercise to tone up the muscle that acts as a corset to support the back which may be important when I start to get used to life without the brace. I still can't put my full weight on my broken right leg, but it is getting stronger every day and you can almost see some of my leg muscles again.

Finally, since joining the Yahoo group (see above) I have been contacted by Patrick who, following a nasty motor bike accident, was treated at the same hospital and by the same staff as I am. He now has his frames off after 7 months and is continuing his recovery. I take such communication as a positive inspiration and look forward to being able to pass on similar encouragement to others

Picture This

The physio regime is pretty mild but does look as if it is starting to improve the mobility and strength of my right leg. Most of the exercises are constrained by the frame on my left leg but that is already in better shape than my right. As far as this leg is concerned my priority is to visualise the movement of my foot based upon muscle stimuli. Time will tell how successful this is.

I managed the stairs twice yesterday so either my stamina or technique is improving - perhaps even both. As I do more exercise I can really feel the need for the painkillers. An earlier attempt to cut down the dosage was a big mistake and I will not try that again for a while.

I have attached a couple of photos to this post. These were taken in hospital and show the frame from both sides. The top picture to some degree shows the wound which is still healing and bleeds when I walk on the leg. The two additional rings at the top will come into play when they start to lengthen my leg to replace the 3-4 cm they had to remove.

I've no idea how much the metalwork weighs, but when I stood on the scales this week I am now 7 lbs lighter than I was when I had the accident despite the extra weight (including my crutches). I think this loss of weight might become very useful when it comes to increasing the exercise load further.

First Physio

Today was my first physio session at the local hospital. Having been collected by ambulance I met Nick who will be the person who is going to inflict a series of torturous exercises on me in the coming months.

A detailed discussion about the nature of the injuries, the pain I was experiencing and the range of movement that I could manage at present was followed by a review of my situation and my ability to walk on crutches without damaging myself.

Nick stressed that during periods of relative inactivity the muscles can waste very quickly and it is important to keep up even a minor level of exercise to prevent and reverse this. Interestingly, this also applies to exercises which apparantly have no effect. For example, whilst I can push the toes on my left foot down, I cannot pull them up. By exercising as if they were rising, and visualising the process ie imagine the muscles contracting and lifting the toes, this will stimulate the body to continue to detect and respond to the signals, even if the effect is not apparant.

We settled on a programme of 5 exercises to keep my leg muscles active. At present we are looking at a small number of repetitions but the message is to listen to my body and respond accordingly. If an exercise gives excessive pain then reduce it, whilst those which are easier can have the repetitions increased gradually.

Nick did want to introduce a back muscle strengthening exercise, but felt that he needed to consult with the hospital in Sheffield before doing so in case it is at odds with their treatment plan for my back.

I am back in a weeks time to review how things have gone.

Over the last couple of days I have been having a lot of pain and have slept very badly. I think my initial mistake was to try and reduce the dosage on some of the painkillers since things seemed to be settling down. I have now returned to to original dosage which seems to be helping the pain and spasms in my left leg. The real problem is being in bed. I am constrained to lie on my back, but I do need to rest my head on 2-3 pillows to help me breath at night. This configuration seems to be giving me a load of backache. I have now tried supporting the length of my back between my hips and shoulders and this does seem to reduce the pain. Still no sleep though.

It appears that recovery from multiple injuries is one long tale of finding and resolving problems. It is difficult to accept this with good grace, but there doesn't seem to be much of an alternative. My motivation must be my final recovery but the measurement of progress must be based on very small steps if I am not to get dispirited.

First Clinic Session

My first clinic session was scheduled for Thursday 29th December. I was transported by ambulance from home to the hospital and back. Both my legs were X-Rayed and Emma checked over my pin sites.

I was concerned that I might have started an infection as I had some very specific pains in some pin sites. I was told in no uncertain terms that if I had an infection I would definitely know about it and that what I was experiencing was the common development of muscles and other internal bits sorting themselves out around the pins. Obviously as you exercise and your musculature changes it has to fit around the pins. I can honestly say that this is now a continuous process with odd cramps and spasms in addition. Thank you for the painkillers!

Emma also cleaned the blood from the open wound from the pins where it had flowed. This remains a real nuisance as every time I walk it bleeds, mainly onto my foot, but then when I sit down and elevate the foot it runs over some of the pin sites. This shouldn't necessarily mean increased risk of infection but it is messy.

The X-Rays were interesting as I finally saw how much damage I had done.

The right femur now holds a nail which is almost as long as the shattered bone around it, with a second nail into the hip joint to provide an anchor. There is evidence of new bone growth so perhaps another 2-3 months will see it fixed.

I had always assumed that I had broken my left ankle as well as the bones in my lower leg, but the Consultant (Mike Dennison) confirmed that my ankle and foot were pretty much undamaged and had only been left attached by a small amount of skin before they squared off the 2 bones and butt jointed them up to the ankle for healing. It is by no means certain that the bones will heal so there is still a possiblity that I will lose my foot, but they remain optimistic and have other options, such as bone grafting, to fall back on.

I have always accepted that there was no guarantee that my left leg could be saved so I am reassured that so far nothing has happened to diminish the optimism. I was a little disappointed when I asked how long the frame might have to remain in place. I had always hoped that 6-9 months might be enough but I am now not expecting to see the back of it in 2006 even if things go to plan.

The future?

I have a physiotherapy appointment on Tuesday 3rd January and return to Sheffield on Thursday 19th January to have my back X-Rayed to see if they can wean me off the brace.

Here's hoping.

Getting Home

I was warned in advance that my first few days at home would be tough.

Even with careful preparation your home is not as "invalid friendly" as the hospital ward. Using crutches for walking means that carrying items can be awkward, especially food & drink. My particular nemesis is our staircase. It is steeper, the treads narrower and the risers higher than the ones I practiced on. Each stair also has a "nose" ie a bit that sticks out over the stair below and they are carpeted. This means lifting my feet higher and wider to climb the stairs where I lead with my left (frame) leg. Going down is even worse because my frame extends behind my foot making it almost impossible to lead with my left leg so I lead with my right (the weaker) leg and support myself more with my arms. Then I reach the bottom stair where I run out of banister (handrail) and have to go down using both crutches. All sorted now, but challenging for the first couple of days.

Establishing a daily routine is taking a bit of time, but at present revolves around the times I take my painkillers. I am able to spend about 11-12 hours a day downstairs in a chair, with the occasional walk to give me some exercise. I expect to do more exercise as my condition improves, but at present I have to be careful if I am to safely mount the stairs to go to bed.

The rest of my hospital stay

The rest of my time in hospital seemed never ending although it only lasted less than 3 weeks.

I was fitted for a back brace which I had to wear any time I got out of bed. It is a fine creation of plastic and velcro but cannot really be regarded as comfortable. Having got the brace I was then "encouraged" to get out of bed and by the Monday I was expected to walk with a Zimmer frame.

I remain amazed that both my broken limbs are expected to be able to support my body weight, even though by now my weight had somewhat diminished. From the perspective of an Ilizarov wearer it is initially difficult to place your trust in the fixation device, but it really does allow you to weight bear and even walk. Of course it feels strange, especially as my device is fastened into my heel and my ankle is fixed, but even now I regard my left leg as my good leg compared to the right which, even with the femeral nail, is still weaker and less stable. As my left leg had been shortened, the Occupational Therapy team (Jill & Melissa) fixed me up with a customised sandle which pretty much balanced up my legs meaning that I didn't walk in circles all the time.

Daily physio courtesy of Jackie and her colleagues, and other support led me to progressing to crutches and, joy oh joy, the ability to get to the toilet unaided - no more bedpans! Unfortunately I have a large wound on my left leg where the flesh has yet to heal. This still bleeds when I walk and frequently leaves a distinctive trail, but more importantly is a potential site for infection which means no hydrotherapy.

Most of the rest of my stay was geared towards preparing me for going home. My injuries were carefully monitored and we were trained in the care of the frame and, most importantly, the cleaning of the pin sites. The pins which fix the frame onto the leg go directly through the flesh and the bone. This means that hygene is critical and infection common. We were trained to clean the pin sites and replace the dressings on a weekly basis. If we have any queries or concerns then the specialist nurses, Maria & Emma, are available to provide help.

Finally, the OT team fixed up the provision of medical aids for home and I was discharged on Thursday 22nd December being delivered home by Ambulance.

What a mess!

This is very brief summary of the immediate aftermath of the accident and the injuries I sustained. Some of this has been reported to me as I was pretty much unconscious for several days and only recall the edited highlights.

Surprisingly, I was quite conscious during the initial rescue and able to provide information to the paramedics. I could tell that I had severly damaged my lower left leg and it felt like I had also broken my right femur. I also had a back pain which prompted additional caution in removing me from the wreckage. I could feel blood on my face but at that stage was not aware of how much damage I had done.

I was taken to the Chesterfield Royal Hospital directly from the crash site being the closest location with suitable facities. They made the initial assessment and concluded that my head and left leg injuries were the most threatening. They stabilised the limbs and then operated to patch up my face and broken nose. They also took X-Rays and a CT scan of my spine and confirmed the presence of a fracture.

The leg injuries were too severe to be fully treated in Chesterfield and I was transferred the following day to the High Dependency Unit at the Northern General in Sheffield and referred to their Trauma team. Simon Royston and his team were incredibly helpful in explaining the general nature of the injuries and the most suitable options for their treatment.
On the Tuesday they fixed up my right leg by inserting a femeral nail.
Wednesday they confirmed that the back injury was a stable fracture of the L2 vertebra and, as such, meant that I could reasonably expect to be able to stand and walk while it healed so long as I wore a suitable brace. This meant that there was the option to fix my left leg, where the Tibia and Fibula were both badly broken near to the ankle, using an Ilizarov frame.
Thursday saw the fitting of the frame. The operation took several hours and they had to remove about 4cm of "dead" bone so they added some rings to the frame to permit the lengthening of my leg when the initial healing was complete.
On Saturday they transferred me out of HDU and into a general ward, almost exactly 6 days after the initial accident.

Throughout this period my wife Maggie had been at my bedside, aided by some of our closest friends who provided food, shelter and transport. I can't help feeling that I had the easy part of that initial week since I was too dosed up on Morphine to really feel much pain and was unconscious for most of it.

Why Blog?

Obviously I didn't plan the accident and so I certainly didn't plan to create this blog.

Having gone through the trauma of the initial hospitalisation and realising that I was to host my new Ilizarov frame for a while, I thought it a good idea to try and find out a bit about what to expect.

The hospital do provide some very useful information about how to improve the healing process and avoid the pitfalls such as infection and muscle wastage, but what about the practical day to day issues?

My initial web search uncovered The Ilizarov & External Fixator Wearer's Support Group run by Slim Haines which was an inspiration to me. I decided immediately that I should document my own experiences as they occur in the hope that they would provide information and, who knows, inspiration to others who find themselves in a similar situation.

In my next post I will provide some idea of my injuries and my progress to date. Beyond that I know no more than anyone else at this point.

Where to start?

It is New Years Day 2006, a year that I now face with my left leg attached to a modest scaffold constructed from the finest Meccano I have ever seen.

The cause of this was an accident which occured while I was gliding in late November.

It is not important to this story to try and explain how the accident happened. Any aviation sport carries risks and all pilots acknowledge those risks when they fly. Gliding is inherently very safe and well managed at both national and regional levels. However, accidents can, and do, happen. My accident will be the subject of a formal investigation and report which will highlight the lessons to be learned for future pilots. Until then I will confine my comments to a plea that this, or any other accident, should not put anyone off engaging in this most wonderful sport.

As far as the tale goes, I have no idea where it will lead, but obviously I hope it will end with me fully recovered and flying again. Only time will tell.